chapter 4

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chapter 4
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2014-05-20 01:00:36
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  1. HAI STATISTIC
    • 5% all patients develop an hai
    • 15% hais are pneumonias 
    • 25% of patients undergoing mechanical develop pneumonia
    • 30% of these patient die 

    about 100,000 deaths annually
  2. define nosocomial infection
    infection acquired in the hospital. and diagnose 48 hrs after admittance
  3. explain how nosocomial infection is differentiated from community acquired infection
    nosocomial infection is something that develops in the hospital and community acquired are infections that pts are admitted in to the hospital with
  4. describe the impact of nosocomial infection on pt outcomes and healthcare cost
    a nosocomial infection may require the pt to stay longer in the hospital esimated on 13 days consequently increasing health care cost, it cost 3-6,000 per episode.
  5. explain the factors that increase infection risk for respiratory care patients
    age, immunocompromised host,
  6. describe the elements of a chain of infection
    • source of pathogen >
    • Route(contact, respiratory droplets, airborne droplet nuclei) >
    • susceptible host
  7. list & explain the routes by which pathogens are transmitted from source to host
    • CONTACT
    • direct-there is direct contact between souce and host
    • indirect-pathogens are transmitted through fomites

    • DROPLET TRANSMISSION
    • form of contact, fluids lands on your mouth or nose < 3 feet 

    • AIRBORNE DROPLET NUCLEI
    • droplets <5 microM, these remain suspended in air and can be inhaled by host!
  8. what is the primary source of infection
    humans
  9. describe the most common reason HCW state prevents them from performing hand washing
    theres no time
  10. OSHA mandates what vaccine
    hep b vaccine
  11. post exposure chemoprophylaxis is recommended for
    • bordetella pertussis
    • N. meningitidis 
    • Bacillus anthracis
    • influenZA
    • HIV
    • group A streptococci
  12. how long should you hand wash for?
    atleast 15 min
  13. describe two elements of standard precautions
    hand hygiene consists of washing hands properly

    equipment handling- making sure equipment is aseptic

    patient placement-
  14. airborne precautions used for what condition
    • legionellosis
    • tuberculosis
    • varicella
    • measles
    • smallpox
  15. list conditions in which droplet precautions are used
    • diphtheria
    • pertusis
    • streptococcal pneumonia
    • influenza
    • mumps
    • rubella
    • adenovirus
    • haemophilus influenzae
    • neisseria meningitidis pnemonia
  16. list conditions in which contact precautions are used
    • DIRECT
    • hep a
    • hiv
    • staphylococcus
    • enteric bacteria
    • INDIRECT
    • pseudomonas aeruginosa
    • enteric bacteria
    • hep b & c
    • hiv
  17. Explain the guidelines for using Isolation Precautions
    isolating pt. appropriately based on the pathogen pt is infected with
  18. what are the proper procedure for using both clean and sterile gloves
    • clean gloves should be used in not "invasive" procedures
    • Sterile gloves should be used in invasive procedures eg. suctioning
  19. what situation will require gloves changed(list 9 atleast)
    • after a procedure
    • after every patient
    • when you change site of tx
    • once it becomes grossly dirty
  20. procedure that do not routinely require glove use (atleast 6)
    • none invasive procedures
    • checking pulse
    • pressure
    • osculating
  21. what is the regulatory context for respiratory protection?
    • medical clearance 
    • use of appropriate niosh-approved fit -tested respirators
    • education in respirator use
  22. describe situations when face mask, googles and face shields are required
    situation in which we will be exposed to body secretions during procedures, or also during surgery when we are protecting the pt from other pathogens
  23. airborne precautions
    place pt in a negative pressure room that has 6-12 air changes per hr and either safe external air discharge or HEPA filtration of recirculated air 

    KEEP DOOR CLOSE
  24. air quality for patients with stem cell transplants improved by
    HEPA filtration of coming air

    directed room flow

    possitive air room pressure relative to corridor 

    well sealed room(prevent infiltration of outside air 

    12< air changes per hr 

    • reduce dust 
    • no plants or pots
  25. what is the correct sequence for donning and doffing PPE
    • DONNING
    • gown>mask>eyewear>gloves

    • DOFFING
    • gloves>eyewear>gown> gown
  26. discuss the guidelines for preventing needle sticks
    • ONE HANDED RECAPPING
    • place the cap on the counter top and slide the needle into the cap
    • tilt the needle up to slide the cap down
    • press the cap onto the needle hub
  27. cleaning 
    removal of all foreing materials from objects 
  28. bronchoscope sterilization
    clean with water n detergent or enzyme cleaner 

    disinfect immerse in high level disinfectant for min 20min.

    rinse with water

    dry with force air 

    store hund vertically in an enclosed cabinet bronchoscope should not touch cabinet 
  29. how do you properly clean?
    disassemble and examine worn parts 

    then sumerge in hot water with soap detergent or enzymatic cleaners
  30. physical method for disinfection 
    pastuerization
  31. high level disinfection
    • 2.4 < glutaraldehyde
    • .55 opa
    • .95 gluteraldehyde with 1.64 phenolphanate 
    • 7.35 hydrogen peroxide with .23 peracetic acid
    • 1.0 hydrogen peroxide with .08 pa
    • 7.5 hydrogen peroxide 
  32. explain Spaulding categories of equipment infection risk
    • critical: sterile tissue and vascular system
    • semi-critical: mucous membrane  
    • non critical: intact skin
  33. chemical disinfectant agents most commonly used
    • alcohol
    • chlorine
    • glutaraldehyde
    • idophors
    • phenolics
    • quaternary ammonium compounds
    • paracetic
    • hydrogen peroxide
  34. physical and chemical methods commonly used in hospital equipment sterilization
    • PHYSICAL: steam(eto gas), ionizing radiation,
    • CHEMICAL: low temp use of eto
  35. autoclaving combo
    15psi at 121o C
  36. acute exposure to eto side effects
    • airway inflammation
    • nausea
    • diarrhea
    • headache 
    • dizziness
    • convulsions
  37. chronic exposure to eto
    • respiratory infections
    • anemia 
    • aletered behavior
  38. eto is explosive at
    3%
  39. proper handling of respiratory care equipment to minimize spread of infection
    • maintenance of in-use equipment
    • processing of reusable equipment
    • do not reuse disposable material
    • fluid and med precaution
  40. small volume nebulizers have been associated with? due to?
    nosocomial pne like legionnaires 

    due to contaminated medications and contaminated tap water left in reservoir
  41. what type of water should be used in bubble type humidifiers
    sterile water
  42. how often should you sterilize large volume nebulizers 
    between patients and after 24 hours of use on the same patient 

    MUST BE STERILIZED OR HIGH LEVEL DISINFECTION 
  43. how do you reduce or eliminate circuit condensation 
    • with a heat and moisture exchanger 
    •  
    • IT CAN BE USE MAS 96 HRS
  44. explain procedures for transporting infectious pt.
    depending on the pt contagious disease, pt will  wear mask, gown etc.
  45. describe procedures for obtaining and handling laboratory specimens
    maintain everything clean, externally, disinfect it and put in an impervious bag to prevent spreading
  46. describe process of microbial surveillance and the role of clinical microbiological lab
    • investigation
    • prevention
    • control
    • reporting

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